Medical setting offer unique opportunities to screen and intervene for patients with alcohol use disorders (AUD's), but few medical settings have incorporated these services into their clinical routines. Barriers to the management of AUD's in medical settings are the lack of data on interventions beyond brief interventions for alcohol abusers, the lack of data on interventions for alcohol dependent patients who decline specialized treatment, difficulty engaging primary health care providers in alcohol screening and intervention, and cost constraints. A randomized controlled trial will assess the efficacy of a counselor-administered, telephone and mail intervention (TAMI) compared to a health lifestyles pamphlet; all subjects will receive usual medical care. 22,500 patients will be systematically screened in 9 primary care and managed care clinics in Madison and Milwaukee, Wisconsin, to identify 900 subjects. Subjects will be of ages 21 to 59, able to speak English, not pregnant, and not suicidal, with AUDIT scores of greater than or equal to 8 and DSM-IV diagnoses of alcohol abuse or dependence. The experimental intervention is based on Prochaska and DiClemente's stages of readiness to change and Miller and Rollnick's model of motivational interviewing. It will include six 30-minute, structured telephone counseling sessions and post-session summary letters. Primary outcome measures, to be assessed at baseline, 3-, 6-, and 12-months, are total alcohol consumption and days of heavy drinking (greater than 4 drinks for men, greater than 3 drinks for women) over the past 28 days. An intention-to-treat analysis will use a generalized estimation equation approach. A benefit-cost analysis will be performed using 12-months of pre- and post-TAMI data on health care utilization and criminal justice and motor vehicle events. Additional analyses will focus on the predictors of efficacy, the subjects' satisfaction with TAMI, and pre- and post-TAMI pharmaceutical use. This study has the potential to establish an efficient, cost-effective, convenient intervention for AUD's in primary and managed care settings.